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Browsing by Author "Lutz, Andrew"
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Item Epidemiology and Risk Factors for Invasive Fungal Infections in Pancreas Transplant in the Absence of Postoperative Antifungal Prophylaxis(Oxford University Press, 2023-09-26) Zachary, Jessica; Chen, Jeanne M.; Sharfuddin, Asif; Yaqub, Muhammad; Lutz, Andrew; Powelson, John; Fridell, Jonathan A.; Barros, Nicolas; Medicine, School of MedicineBackground: Invasive fungal infections (IFIs) remain a rare yet dreaded complication following pancreas transplantation. Current guidelines recommend antifungal prophylaxis in patients with 1 or more risk factors. At our center, single-dose antifungal prophylaxis is administered in the operating room but none subsequently, regardless of risk factors. Here we evaluate the 1-year incidence, outcome, and risk factors associated with IFI following pancreas transplantation. Methods: A retrospective, single-center cohort study was conducted in patients who underwent pancreas transplantation between 1 January 2009 and 31 December 2019. Records were manually reviewed, and cases were adjudicated using consensus definitions. The 1-year cumulative incidence, mortality, and risk factors were analyzed by Kaplan-Meier method and differences between populations were assessed with Fisher test and Mann-Whitney U test. Results: Three hundred sixty-nine recipients were included. Twelve IFIs were identified: candidiasis (8), aspergillosis (2), histoplasmosis (1), and cryptococcosis (1). Intra-abdominal infections were the most common presentation (5), followed by bloodstream infections (3), disseminated disease (2), pulmonary disease (1), and invasive fungal sinusitis (1). Median time to IFI was 64 days (interquartile range, 30-234 days). One-year cumulative incidence was 3.25% (95% confidence interval, 1.86%-5.65%). There were no significant differences between patients with or without IFI regarding type of transplant (P = .17), posttransplant dialysis (P = .3), rejection (P = .5), cytomegalovirus serostatus (P = .45), or reoperation (P = .19). For patients with IFI, the 1-year graft and patient survival rates were 58% versus 95% (P < .0001) and 75% versus 98.6% (P < .001), respectively. Conclusions: Our study suggests that the use of a single-dose antifungal prophylaxis administered in the operating room but none subsequently does not result in an increased incidence of IFI following pancreas transplantation.Item Pancreas transplantation following total pancreatectomy for chronic pancreatitis(Wiley, 2019-12) Cerise, Adam; Nagaraju, Santosh; Powelson, John A.; Lutz, Andrew; Fridell, Jonathan A.; Surgery, School of MedicineBackground Total pancreatectomy for chronic pancreatitis leads to brittle diabetes and challenging glycemic control with half of all patients experiencing severe hypoglycemia, many requiring medical intervention or hospitalization. Pancreas transplantation has the potential to manage both the endocrine and the exocrine insufficiency in this patient population. Methods Between June 1, 2005, and July 1, 2016, 8 patients with brittle diabetes following total pancreatectomy underwent pancreas transplantation. All grafts had systemic venous and enteric exocrine drainage. Data included demographics, graft and patient survival, pre‐ and post‐transplant supplementation with pancreatic enzymes, and narcotic usage. Results Patient survival rate at 1 and 3 years was 88%. Pancreas graft survival rate of those alive at 1 year was 100% and 86%, respectively. About 75% of these patients remained insulin‐free until their time of death, loss of follow‐up, or present day. Of the patients with maintained graft function at 3 years, none required further hospitalization for glycemic control. About 75% of these patients have also maintained exocrine function without pancreatic enzyme supplementation. Conclusions Pancreas transplant can treat both exocrine and endocrine insufficiency and give long‐term insulin‐free survival and should be considered as a viable treatment option for patients who have undergone total pancreatectomy for chronic pancreatitis.Item Rabbit anti‐thymocyte globulin administration to treat rejection in simultaneous pancreas and kidney transplant recipients with recent COVID‐19 infection(Wiley, 2020) Barros, Nicolas; Sharfuddin, Asif A.; Powelson, John; Yaqub, Muhammad; Adebiyi, Oluwafisayo O.; Beeler, Cole; Lutz, Andrew; Fridell, Jonathan A.; Medicine, School of MedicineTransplant recipients may be more susceptible to COVID‐19 and itsrelated complications.1‐3Despite most patients being managed with reduction of immunosuppression, the risk of rejection or graft loss does not seem to be increased during COVID‐19.